Provider Demographics
NPI:1043507346
Name:RHOADS, TANIA (CISW, SAC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:RHOADS
Suffix:
Gender:F
Credentials:CISW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FOREST AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4155
Mailing Address - Country:US
Mailing Address - Phone:920-907-0813
Mailing Address - Fax:920-907-0826
Practice Address - Street 1:17 FOREST AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4155
Practice Address - Country:US
Practice Address - Phone:920-907-0813
Practice Address - Fax:920-907-0826
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15431-131101YA0400X
WI901-122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)